Cirrhosis and pregnancy. A case report and review of the literature

A clinical case of a pregnant suffering from hepatic cirrhosis with ascites, splenomegaly and portal hypertension is described. The pregnancy carried on till the 31st week, even though with the repeated use of tocholytic agents. Cesarean section was performed because of the onset of serious jaundice and the decline of general maternal conditions. The infant, who had an Apgar score of 8 at the 1st and 5th minute, died on the 10th day because of accuse haemorrhagic interstitial pneumonitis in premature lungs and hepatopathy associated with widespread jaundice. The mother was discharged on the 25th day of the postpartum period, in light of the net improvement of her general metabolic condition, the sudden regression of the jaundice and the decrease of the cholestasis indices. A review of the literature discussing maternal complications fetal risks, management of pregnancy and delivery and outcome of the newborn are presented.     

Intrapericardial teratoma. A case report and a literature review

A case of newborn intrapericardial teratoma is reported. The clinical, echocardiographic, tomographic and histologic features are described, and also, the therapeutic options. The newborn was submitted to surgical excision of the intrapericardial tumor and has a clinical follow-up greater than four years.     

Extraskeletal retroperitoneal osteosarcoma. A case report and review of the literature

Extraskeletal osteosarcomas, localized in the retroperitoneal space, are very rare neoplasms (only 200 cases have been described); the case indicated is the second one observed in Literature. The extraskeletal osteosarcomas are very malignant mesenchymal neoplasms reproducing osseous and cartilaginous tissue disconnected from the skeletal system. From a histological point of view, the extraskeletal osteosarcomas are constituted of osseous and cartilaginous tissue with osteo-fibro-chondroblastic cells: the different representation of three types of cells define the variety of extraskeletal osteosarcomas (osteoblastic, chondroblastic, fibroblastic). Histological and ultrastructural study failed to find differences between skeletal and extraskeletal osteosarcomas. In the clinical history of some patients traumas or irradiation has been referred; although extraskeletal osteosarcomas etiology is frequently unknown. Diagnosis is generally delayed because symptoms are often absent of uncertain. Prognosis of these neoplasms is always very poor, and specially in relation to the dimension and to the possibility of its radical removal. All patients died until 2-3 years after surgery.     

Septicemia due to Shigella. A case report and review of the literature

To develop a proper protocol for biological exposure monitoring of acetone, we evaluated whether exposure to acetone on the previous day affects the biological monitoring value at the end of a work day. One hundred and ten male workers exposed to acetone in three acetate fiber manufacturing plants were monitored using a liquid passive sampler on two consecutive working days after 2 days without exposure. Urine samples were collected at the start of the workshift and the end of the shift on both days for each subject. For ten exposed workers urine samples were collected approximately every 2 h during and after the first working day until the following morning. Acetone concentrations in urine (Cu) at the start of the first working day were 1.3 +/- 2.4 (range: ND-14.1) mg/l in nonexposed workers and 2.4 +/- 5.6 (range: ND-40.3) mg/l in exposed workers. The urinary acetone concentration at the beginning of the second working day indicated that urinary levels of acetone do not decline to background level by the following morning when exposure concentration exceeds 300 ppm. However, linear regression analysis demonstrated that the relationship between environmental exposure level and urine level was similar on the 1st day and the 2nd day. Thus, although urine acetone levels did not return completely to baseline after high exposures, under the present exposure levels the exposure on the previous day did not significantly affect urinary acetone at the end of the workshift of the next day.     

Primary tracheal non-Hodgkin's lymphoma. A case report and review of the literature

BACKGROUND: Primary tracheobronchial non-Hodgkin's lymphoma (NHL) is an uncommon occurrence. The authors report a patient who presented with primary tracheal NHL, the sixth such patient described in the literature. METHODS: Using a MEDLINE search, 41 additional patients presenting with symptomatic primary or secondary tracheobronchial NHL were identified. The characteristics, management, and outcome of these patients are described. RESULTS: Patients with NHL of the upper respiratory tract present with dyspnea, wheezing, and cough, and frequently are misdiagnosed as having asthma. The majority of patients have additional sites of intrathoracic disease with tracheobronchial involvement occurring in the setting of advanced or relapsed NHL. Low grade histology is seen most commonly in patients with primary tracheal NHL. Several patients demonstrate the typical histologic features of mucosa-associated lymphoid tissue. Surgery, chemotherapy, and radiation therapy have been used alone or in combination for treatment. The outcome of these patients does not appear different from that observed in patients with lymphomas of similar histology and stage that do not involve the tracheobronchial tree. CONCLUSIONS: Thoracic surgeons, pulmonologists, and oncologists should recognize that NHL can rarely be confined to the trachea or bronchi. NHL should be considered in the differential diagnosis of airway obstruction, because it represents a highly treatable malignancy.     

Congenital pseudoarthrosis of the radius. A case report and review of the literature

Congenital pseudoarthrosis of the radius (CPR) is rare. Only ten cases seem to have been found in the literature. Congenital pseudoarthrosis of the radius usually is associated with neurofibromatosis or fibrous dysplasia. This is a report of a congenital pseudoarthrosis of the left radius associated with congenital dislocation of the left hip in a five-month-old girl. Apart from the pseudoarthrosis, there were no visible abnormalities. This patient was treated successfully with excision of the pseudoarthrosis, shortening osteotomy of the ulna, grafting, and intramedullary fixation of both the radius and the ulna. Review of the literature disclosed the extreme difficulties in treating this condition. It was also found that vascularized fibular graft has been used successfully.     

Nonoperative treatment of cerebellar abscesses. A case report and review of the literature

A case of a 5-year-old child presenting with a cerebellar abscess occupying the ponto-cerebellar region, who was treated with antibiotic therapy alone, is reported. Symptomatology, radiological findings, and antibiotic regimens are presented, and the literature is reviewed from the viewpoint of therapeutic management.     

Vertebral hemangioma symptomatic during pregnancy. A case report and review of the literature

A simple four-tube arteries-microvessels-veins system which simulates a more realistic loading for human circulation was built using transmission line network. Hemodynamic data from literature are used in the fluid-circuit analogy, and the flow leakage and viscoelastic properties of the blood vessels have been considered. The effect of veins on the input impedance spectrum was found to be negligibly small above 0.5 Hz. The predicted input impedance spectra agree reasonably well with the published measurements both in shape and magnitude. Parametric analysis shows that the changes of vascular properties in the lower body affect the first minimum, and the changes in the upper body influence the second minimum. The blood flow in and out of kidney and liver dominates the aortic impedance from 0 to 5 Hz. Decreasing capacitance (i.e., increasing arterial stiffness due to aging), reducing the lumen area, or decreasing the length of blood vessels result in an increase in the impedance modulus, and the first minimum shift to a higher frequency which agree well with experiments. In the current model, the pressure, flow waveform, and local impedance can be predicted at any location along the circulatory tree. The characteristic of arterial pulse propagation resembles published measurements.     

A rare case of ovarian leiomyoma. A case report with review of literature]

We report an exceptional case of ovarian leiomyoma in 73 years old patient. Leiomyoma of the ovary is a very rare tumor. Most cases are asymptomatic, this benign neoplasm is usually found incidentally on routine pelvic examination, at surgery or at autopsy. The available literature is reviewed. The possible histogenesis of ovarian leiomyoma was discussed.     

Syringomatous tumor of the nipple. A case report and review of the literature]

The authors report a case of syringomatous tumor of the nipple in a 35-year-old woman, discovered incidentally during investigation of dysmenorrhea. After limited resection-biopsy of a cystic nipple tumor, histological results indicated the need for a partial central mastectomy with areola and nipple amputation. Although this tumor is classified as an adenoma, considered to be a benign lesion, syringomatous adenoma of the nipple is a potentially locally aggressive tumor, at risk of local recurrence and deep invasion of the mammary gland. This is a rare tumor (only 18 cases have been reported in the literature), and the histological diagnosis can be difficult, with possible confusion with a nipple duct adenoma, or tubular carcinoma.     

Granulomatous hypophysitis caused by a ruptured intrasellar Rathke''s cleft cyst: report of a case and review of the literature

STUDY OBJECTIVES: To determine the clinical significance of Candida sp isolated from bronchoscopic samples in patients with suspected pneumonia. DESIGN: A retrospective chart review was performed in all nonneutropenic adult patients with Candida sp isolates from respiratory secretions obtained by bronchoscopy over a 5-year period (1991 to 1995). Potential risk factors, therapeutic decisions, and outcome were recorded. Microbiological findings, chest radiograph reports, and pathologic material were reviewed. Isolates were classified as definite, probable, or indeterminate contamination, or as definite pulmonary candidiasis, on the basis of histologic findings, therapeutic decisions, and outcome. SETTING: A 600-bed teaching hospital with 16 beds in a medical-surgical ICU. PATIENTS: Thirty-seven consecutive patients with positive cultures for Candida sp from respiratory samples obtained by bronchoscopy were evaluated. Thirty-two of these 37 patients (86.5%) received antibiotic therapy prior to sampling, and 23 (62.2%) were intubated. RESULTS: Contamination was classified as definite in 3 patients (8.1%) and probable in 30 others (81.0%). Contamination was indeterminate in two cases (5.4%). Two additional patients (5.4%) received antifungal agents for systemic candidiasis. No cases of pulmonary candidiasis could be demonstrated, although 24 of 28 patients showed protected specimen brush cultures > or = 10(3) cfu/mL. CONCLUSIONS: Nonneutropenic patients with isolation of Candida sp from bronchoscopic samples, even in high concentrations, are unlikely to have invasive candidiasis. Indication for initiation of antifungal therapy should be based on histologic evidence or identification from sterile specimens.     

Necrotizing fasciitis following postpartum tubal ligation. A case report and review of the literature

Necrotizing fasciitis is a rare, but devastating subcutaneous bacterial infection which occurs following breaks in skin integrity, either natural, post traumatic or post surgical. Although it has been described following many surgical procedures, necrotizing fasciitis has not been previously described following postpartum tubal ligation. Necrotizing fasciitis was diagnosed four days after an uncomplicated postpartum tubal ligation via an infraumbilical incision. Rapid surgical debridement with broad spectrum antibiotic coverage provided successful therapy. Postpartum tubal ligation is one of the most common surgical procedures in obstetrics and gynecology, thus reports of complications resulting from this procedure are quite relevant to clinical practice. We present here the first reported case of necrotizing fasciitis following postpartum tubal ligation through an infraumbilical incision.     

Polypoid carcinoid tumor of the stomach. A case report and a review of the literature

A gastric carcinoid presented as a polyp with a stalk.     

Anomalies of umbilical vein in the fetus. A case report and review of the literature

Measuring the incidence of the human immunodeficiency virus (HIV) is of vital importance but can be difficult and costly. We compared HIV-1 incidence measured directly from prospective cohort studies with rates derived from a method using the prevalence of HIV-1 antibody-negative, p24-antigen-positive individuals. Male and female commercial sex workers (CSWs) were enrolled and followed in separate cohort studies in northern Thailand between 1989 and 1994, and HIV incidence was measured by prospective follow-up of individuals seronegative at baseline. In 1991-1992 cross-sectional serosurveys were done among male and female CSWs in the same region; all HIV-1 antibody-negative subjects in these surveys were tested for p24 antigenemia. HIV incidence was estimated using the prevalence of p24 antigen and a model based on the mean duration of p24 antigenemia before HIV antibody detection. The cohort studies showed high initial incidence rates-23.8/100 person-years (PY) among female CSWs and 11.9/100 PY among male CSWs-but poor compliance with prospective follow-up. Subjects lost to follow-up appeared to be at greater risk of HIV seroconversion than those retained. The p24 antigen method estimate among female CSWs, 25.4%/year, was quite similar to the initial incidence rate found in the cohort. The estimate by the p24 antigen method was higher, 19.9%/year, among male CSWs than that measured prospectively. In populations with high rates of HIV transmission and in whom long-term follow-up is incomplete, estimates of incidence using p24 antigen prevalence among antibody-negative subjects can give useful and economical estimates of HIV incidence and allow for estimates of whether the incidence rates are similar in subjects successfully followed and those lost to follow-up.     

Unilateral Blastomyces dermatitidis endophthalmitis and orbital cellulitis. A case report and literature review

PURPOSE: The authors report the clinical, cytologic, and histopathologic findings of a unique presentation of concomitant unilateral endophthalmitis and orbital cellulitis secondary to Blastomyces dermatitidis. DESIGN: Case report. METHODS: A 29-year-old healthy woman with a history of pulmonary tuberculosis presented with a painful right eye and rapidly decreasing vision. Fundus examination showed a diffuse elevated choroidal lesion at the posterior pole. With an otherwise unremarkable systemic work-up, the patient was treated with systemic antibiotics and corticosteroids for a presumed diagnosis of choroidal tuberculous granuloma. After an initial response to the treatment, the patient's condition deteriorated rapidly with visual acuity decreasing from 20/25 to no light perception in 3 months. Ipsilateral proptosis developed with magnetic resonance imaging showing a poorly defined orbital mass. Surgical enucleation and an orbital biopsy were performed. RESULTS: Histopathologic examination of the orbital specimen and an intact enucleated globe showed a diffuse necrotizing granulomatous process with the presence of numerous yeasts consistent with B. dermatitidis. This subsequently was confirmed by positive culture of B. dermatitidis from the orbital specimen. CONCLUSIONS: This is a unique case of concurrent unilateral endophthalmitis and orbital cellulitis secondary to B. dermatitidis. Intraocular dissemination of blastomycosis should be suspected in the differential diagnosis of endophthalmitis in patients with previous or active pulmonary lesions of equivocal nature. Early diagnosis and prompt treatment with antifungal medications are essential.     

Primary coexistent adenocarcinoma and choriocarcinoma of the stomach. A case report and review of the literature

We report a case of primary gastric choriocarcinoma with liver metastasis. The mixed histologic patterns included adenocarcinoma, undifferentiated carcinoma, and choriocarcinoma. Immunohistologic staining for the beta-subunit of human chorionic gonadotrophin (beta-HCG) showed positive results in the choriocarcinoma, adenocarcinoma, and normal mucosal gland. However, positive HCG cells were present at different intensities in the choriocarcinoma, adenocarcinoma, and normal mucosal gland. The level of HCG was significantly increased in serum. This unusual tumor probably resulted from dedifferentiation of a primary adenocarcinoma or developed directly from the mucosal glands.     

Chylothorax: case report and review of literature

C57BL/6J-Min/+ mice, which are heterozygous for a non-sense mutation in the Apc gene, provide a model for both familial adenomatous polyposis and sporadic colon cancers. In our study, gut tumors and small intestine lymphoid nodules were counted in Min mice fed fiber-enriched diets for 6 weeks. Neither starch-free wheat bran nor resistant starch modified the number of tumors. However, short-chain fructo-oligosaccharides dramatically reduced the incidence of colon tumors and concomitantly developed gut-associated lymphoid tissue. Our experiment shows that short-chain fructo-oligosaccharides counteract advanced stages of colon carcinogenesis, possibly via stimulation of antitumoral immunity by modulation of the colonic ecosystem.